Study Finds Trends and Disparities in EOL Care for Patients With Hematologic Malignancies

Studies suggest that patients with hematologic malignancies receive more aggressive end-of-life (EOL) care than those with solid tumors.

In addition, racial and ethnic minorities are reported to have lower rates of hospice care, advanced directive (AD) use, and palliative care use. Researchers assessed differences in hospital use patterns and documentation of advanced care planning between patients with solid tumors and hematologic malignancies. And in a subgroup analysis, they examined differences in outcomes associated with racial and ethnic minority status in patients with hematologic malignancies. Kedar Kirtane, MD, at the Fred Hutchinson Cancer Research Center at the University of Washington in Seattle, discussed the findings at the ASH Annual Meeting.

The retrospective cohort study included 9,469 patients with cancer who received care at the University of Washington Medicine and died between 2010 and 2015. The researchers collected administrative data during the last 30 days of life for emergency department (ED) use, hospitalizations, and intensive care unit (ICU) use. Researchers also assessed death in a hospital and any documentation of AD in a patient’s electronic health record (EHR). They adjusted for confounders, including age at death, patient gender, racial or ethnic minority status, level of education, insurance type, attributed facility, and number of Dartmouth Atlas chronic conditions. The researchers only included patients who had at least one day of the relevant type of care.

“Patients with hematologic malignancies received more aggressive care at the end of life,” the researchers reported. In the last 30 days of life, patients with hematologic cancer were significantly more likely to have aggressive, hospital-based care, which was based on inpatient care, hospitalization for at least 14 days, multiple hospital admissions, and more days of hospital care, once admitted, than those with solid tumors. They were also significantly more likely to have received intensive care and to have spent more time in the ICU once admitted in the last 30 days of life. Patients with hematologic malignancies were more likely to have died in a hospital and were more likely to have had documentation of AD in their EHR.

Among patients with hematologic malignancies, racial or ethnic minorities were less likely than white non-Hispanics to have documentation of AD and more likely to have at least two ED visits or at least 14 days of inpatient care. They also had more days of inpatient care and ICU care once admitted in the last 30 days of life (see Table 1).

“Although these are administrative data, they suggest opportunities to improve EOL care for patients with hematologic malignancies, particularly racial or ethnic minorities,” the researchers concluded.